| NPI | 1528158284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2008015504) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 46590-020) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2017-12-11 |