| NPI | 1588810451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 48081) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 48081) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD042000) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2019-05-24 |