| NPI | 1699766584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0047290) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G74569) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2011-09-16 |