| NPI | 1679682413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MT 7630) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 1679682413) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MT 7630) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-12-28 |