| NPI | 1497720247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: FL ME93477) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME93477) |
| 2085R0203X Radiology Therapeutic Radiology (Licence: FL ME93477) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME93477) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2012-10-01 |