| NPI | 1255325262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301104034) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 205707) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301104034) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 1833495) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2022-07-29 |