| NPI | 1487742029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: DC MD036326) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101240153) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-12-14 |