| NPI | 1740241371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD064782L) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0057891) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D0057891) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-08-27 |