| NPI | 1154322071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0065103) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 983527) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2020-05-28 |