| NPI | 1306047733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 31074) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL31074) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC LL31074) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-10-27 |