| NPI | 1396836730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A99602) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: CA A99602) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A99602) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-02-07 |