| NPI | 1245650258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101269308) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q9576) |
| 208D00000X General Practice (Licence: TX Q9576) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2020-10-14 |