| NPI | 1487863767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD045098) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-6716) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241329) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-03-17 |