| NPI | 1174513709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101235651) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD33476) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101235651) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2008-01-16 |