| NPI | 1962664086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 67766) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME 116000) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 116000) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2025-11-20 |