| NPI | 1306150362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A154911) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME 122389) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 122389) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2021-12-17 |