| NPI | 1407832587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 31701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31701) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME118684) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 1718) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-09-03 |