| NPI | 1740375690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0008883) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0008883) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101037410) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-11-18 |