| NPI | 1013986249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM 2006-0257) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 27343) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NM 2006-0257) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2019-12-20 |