NPI | 1558651091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: TX P7030) |
Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 265778) |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 20A15695) | |
Enumeration Date | 2011-04-18 |
Last Update Date | 2025-03-28 |