| NPI | 1194144113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0064149) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 35048) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 14755A) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2023-01-04 |