| NPI | 1376599548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 057821) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 057821) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 17433) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-01-13 |