| NPI | 1841671690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301504347) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301108022) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 218345) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-07-14 |