| NPI | 1972716140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101246327) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME95489) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101246327) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 245215) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2022-02-04 |