| NPI | 1730169665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25237) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KS 04-333395) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 47044) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2018-03-17 |