| NPI | 1629067327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 11601) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 59330) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 11601) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2019-06-27 |