| NPI | 1700868742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 30286) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 38677) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 38677) | |
| 174400000X Specialist (Licence: KY 30286) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2013-08-07 |