| NPI | 1922079979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D79737) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME150544) |
| Enumeration Date | 2006-01-29 |
| Last Update Date | 2022-04-01 |