| NPI | 1386884864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO DR.0048846) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 128584) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO 48846) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2019-11-08 |