| NPI | 1619198272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 12432) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A83071) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A83071) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-01-20 |