| NPI | 1508120874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 26322) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101264319) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264319) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2024-09-24 |