| NPI | 1184919490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SD 11574) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD-46490) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2020-06-18 |