| NPI | 1487722120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301063208) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301063208) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4304063208) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-01-17 |