| NPI | 1235306226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101270576) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C7-0004049) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME120875) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME120875) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2025-06-26 |