| NPI | 1013059625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 226167) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 233866) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2010-09-02 |