| NPI | 1720289879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 17103) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 100421) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 17103) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2022-01-31 |