| NPI | 1619995628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME54313) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME54313) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G140995) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-09-10 |