| NPI | 1295711828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD073176L) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: PA MD07373176L) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2004001501) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD073176L) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2011-03-08 |