| NPI | 1457322299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: RI 11200) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 1019924) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI 11200) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-07-10 |