| NPI | 1245452275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00963) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2010-00963) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 34637) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 34637) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2017-12-20 |