| NPI | 1760624993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 30624) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101257898) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2018-06-07 |