| NPI | 1295788479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2011-0003) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 25014) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2019-10-21 |