| NPI | 1326048380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101243089) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD040130E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C10006375) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0006375) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD040130E) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-02-08 |