| NPI | 1720033954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD051390L) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD051390L) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2016-03-02 |