| NPI | 1720245319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q1975) |
| Additional Taxonomies | 202K00000X (Licence: CT 49759) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 49759) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 49759) | |
| 208D00000X General Practice (Licence: CT 49759) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-07-21 |