| NPI | 1588871826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301085799) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301085799) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023013326) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2023013326) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-07-18 |