| NPI | 1417929373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO 45004) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 45004) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 43153) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NE 35524) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2023-04-06 |