| NPI | 1104863489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD428724) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MD428724) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-01-11 |