| NPI | 1689660953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 45407) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME94234) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A75980) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2021-06-18 |