| NPI | 1467697870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101250121) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301084255) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101250121) | |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2014-02-07 |