| NPI | 1467870154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 277487) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59709) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 277487) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2022-07-21 |