| NPI | 1972688505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO 36095) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 36095) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: CO 36095) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-06-22 |