| NPI | 1649399338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 060547) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 060547) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2005-01290) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD430802) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-05-06 |