| NPI | 1396972584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 65253) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 65253) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-41721) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA MD-41721) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2022-07-21 |