| NPI | 1336149467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: MN 28532) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 28532) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 28532) | |
| 2085N0700X (Licence: MN 28532) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2009-03-03 |