| NPI | 1720244866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 305646) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 236749) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 260807) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2018-07-16 |