| NPI | 1710148622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P9575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125054679) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2014-11-03 |