| NPI | 1104067651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD449493) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 203BR0202X) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2018-09-11 |