| NPI | 1972643906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 71870) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A97152) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A97152) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-06-28 |