| NPI | 1790990919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301086202) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 66715) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301086202) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2023-11-17 |