| NPI | 1083839864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NH 17097) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 226267) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2017-03-06 |