| NPI | 1275562639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 420057) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-20057) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 19293) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO R5A51) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-08-08 |