| NPI | 1215340633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0063899) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 32505) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 12948A) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-03-23 |