| NPI | 1730154261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301087295) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: MN 42856) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301087295) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2012-06-14 |