| NPI | 1558674689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301096533) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301096533) |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2016-06-13 |