| NPI | 1689627028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 020737) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA a90268) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 020737) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-01-03 |