| NPI | 1114973013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AL MD27476) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 31436) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL MD27476) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-12-05 |