| NPI | 1366458770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0031957) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 22898) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 7358A) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-04-26 |