| NPI | 1649243635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101239623) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0057236) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D0057236) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101239623) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2017-03-06 |