| NPI | 1982868063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO DR.0060778) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0060778) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 62229 - 20) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-11-14 |