| NPI | 1790148575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME156448) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME156448) |
| 208600000X Surgery (Licence: IL 125.069449) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-06-14 |