| NPI | 1699791822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A103135) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003004995) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2003004995) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A103135) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-10-28 |