| NPI | 1407955479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 27262) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MN 27262) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-07-13 |