| NPI | 1417150764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A86346) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A86346) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME104527) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME104527) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2018-11-29 |