| NPI | 1881689487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME74591) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 75363) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 75363) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME74591) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2024-04-03 |