| NPI | 1679747265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 274986) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D71136) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2018-08-17 |