| NPI | 1962639757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101265756) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: FL ME142665) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0067125) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0074808) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-06-30 |