| NPI | 1598170664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS16684) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101021321) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL OS16684) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-07-29 |