| NPI | 1437687167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 72915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-10899) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 72915) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA R-10899) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2023-06-13 |