| NPI | 1649413584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2010-0484) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 47749) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA 183820) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2014-03-12 |