| NPI | 1285139345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 76237) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 76237) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-07-20 |