| NPI | 1790782860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME73790) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: FL ME73790) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME73790) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2016-01-21 |