| NPI | 1477558294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-27412) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 114273) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2013-08-01 |