| NPI | 1194767418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MT 9655) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD60709315) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2017-10-26 |