| NPI | 1144410283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 24397) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101246539) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD462508) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2020-08-25 |