| NPI | 1194760876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101254737) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D68016) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D68016) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2013-10-02 |