| NPI | 1760644355 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 072605) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30815) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2018-12-25 |