| NPI | 1568433209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0063751) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GU M-2020) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101054369) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2023-05-09 |