| NPI | 1710501101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME154503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020014727) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL TRN32399) | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2022-06-11 |