| NPI | 1477711919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 68491) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N2024) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 068491) | |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2021-05-27 |