| NPI | 1295725042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD12306) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 49166) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2011-09-22 |