| NPI | 1235175431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101255541) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60406) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 60406) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-08-11 |