| NPI | 1225104599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OR MD27230) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR 27230) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-10-14 |