| NPI | 1104192541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 60421) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60421) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2018-09-11 |