| NPI | 1770726796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 62902) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT198248) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q4685) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301104630) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2017-0070) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2024-04-15 |