| NPI | 1205140373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD455819) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 52289) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD455819) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2019-05-28 |