| NPI | 1962653675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124141) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME124141) |
| 208600000X Surgery (Licence: IL 125.054747) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2016-03-31 |