| NPI | 1417940818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 101239386) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 220316) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 220316) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101239386) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-07-03 |