| NPI | 1790891380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2007018570) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007018570) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-34773) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-01864) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-01-18 |