| NPI | 1316027295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301031753) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301031753) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2012-02-29 |