| NPI | 1578821963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MT MED-PHYS-LIC-129822) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WY 13480A) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MT MED-PHYS-LIC-129822) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO DR.0065827) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NE 33359) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2024-01-12 |