| NPI | 1609071760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M3033) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: ID M3033) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2007-07-08 |