| NPI | 1447396296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 47503) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT189511) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D74384) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 47503) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2015-08-31 |