| NPI | 1154344265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM NM2001-206) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2001206) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM NM2001-206) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-01-15 |