| NPI | 1457665473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD23013) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042.0012505) |
| 2085N0700X Radiology, Neuroradiology (Licence: VT 042.0012505) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2019-06-19 |