| NPI | 1639290562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 51227) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 61164) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME128614) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-09-10 |