| NPI | 1255565024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0054865) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 28428) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 10087A) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2022-03-23 |