| NPI | 1487636551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: TN MD23848) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL 83575) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA C52877) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2012-09-17 |