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 |