| NPI | 1053315499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200100205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 22637) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 22637) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 200100205) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2017-12-20 |