| NPI | 1518304666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301119301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102939) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301119301) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-06-26 |