| NPI | 1265891634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS14859) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC OS14859) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL OS14859) | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2022-07-19 |