| NPI | 1104883966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 47153) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME 93065) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301102162) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-04-09 |