| NPI | 1790791804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 73109) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SD 14201) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-04-30 |