| NPI | 1417239765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC MD35006) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011016067) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2016-01-11 |