| NPI | 1477540961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 20176) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 20176) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-09-14 |