| NPI | 1760642011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 13441) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 236538) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD13341) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2013-06-20 |