| NPI | 1417946534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A42219) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: CA A42219) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A42219) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2012-02-06 |