| NPI | 1265416861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 19469) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME64505) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 19469) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 30133) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2024-04-15 |