| NPI | 1679564892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME109958) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: IA 32726) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA 32726) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2012-07-12 |