| NPI | 1659366896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD421046) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD421046) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2019-08-28 |