| NPI | 1780974105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD461182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0010245) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0010245) | |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2021-07-07 |