| NPI | 1760620116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 050031) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CT 050031) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2022-09-29 |