| NPI | 1811285588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 55765) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME135743) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55765) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 69011) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 55637) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2020-08-19 |