| NPI | 1366437170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 73273) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 73273) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2012-08-02 |