| NPI | 1730183187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME104596) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 36956) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-04-26 |