| NPI | 1801026737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 39153) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-12888) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: ID M-12888) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2017-11-21 |