| NPI | 1417113002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 41886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160996) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036.119857) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2023-09-28 |