| NPI | 1225202724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123665) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N9953) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N9953) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2022-09-30 |