| NPI | 1306818042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL MD8635) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 00008635) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2016-10-25 |