| NPI | 1518164425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A121222) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 49942) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A121222) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-05-19 |