| NPI | 1326012634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 210509) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: MA 210509) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 210509) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2018-07-23 |