| NPI | 1922192459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269283) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME132409) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 57177) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-05-21 |