| NPI | 1396743712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 10575R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 10575R) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 10575R) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2011-05-09 |