| NPI | 1689615494 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0027477) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0027477) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24920) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2015-08-17 |