| NPI | 1215169404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 54173) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 54173) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 266159) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 266159) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2018-03-17 |