| NPI | 1306018643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 263069) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 263069) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2017-02-28 |