| NPI | 1336250919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 40352) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC MD034620) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME108492) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-06-21 |