| NPI | 1548265960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-29014) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2004034150) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2010-12-16 |