| NPI | 1811121858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0009978) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD455399) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: DE C1-0009978) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2025-02-10 |