| NPI | 1437387214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 5101018123) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P9393) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2015-07-17 |