| NPI | 1609048578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 47550) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301091788) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 47550) | |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2020-09-08 |