| NPI | 1316334675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 52860) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 52860) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME145187) | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2022-02-10 |