| NPI | 1275529729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 038534) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 038534) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G193801) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101059081) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G193801) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2024-05-30 |