| NPI | 1295730877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME104678) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200401141) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME104678) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 200401141) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2021-09-09 |