| NPI | 1689657405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 17013) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 17013) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME117935) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 28130) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2020-09-08 |