| NPI | 1467408732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2022-1076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME58331) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 311526) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 311526) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-01-04 |