| NPI | 1083786511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 63644-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301079674) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301079674) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2018-04-23 |