| NPI | 1417063991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L4330) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 00022884) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036-098601) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35072763) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD058818L) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2010-01-27 |