| NPI | 1205946753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G60131) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G60131) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-02-06 |