| NPI | 1467537340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A114968) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47572-020) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60003291) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-12-18 |