| NPI | 1154403632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 36595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 9166) |
| 207R00000X Internal Medicine (Licence: IA 36595) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36595) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2009-09-03 |