| NPI | 1558523944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 60126) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60126) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 64765-20) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2024-01-18 |