| NPI | 1265540496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-15796) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 35221) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2012-12-31 |