| NPI | 1003805029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G56692) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA G56692) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G56692) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2014-10-21 |