| NPI | 1154463990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301106519) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: HI MD-13086) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 14787) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2015-04-30 |