| NPI | 1982608725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 16461) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 015991) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ME 015991) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2018-07-24 |