| NPI | 1255340865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 53739) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME65745) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101257553) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2018-04-03 |