| NPI | 1134395445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C7-0004033) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS016894) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2017-01-27 |