| NPI | 1023086501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME116155) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD036148) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2016-02-17 |