| NPI | 1205830809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 45173) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 34466) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 45173) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2008-01-16 |