| NPI | 1366521734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 44667) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A87282) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME101199) | |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2017-10-24 |