| NPI | 1780678052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 10517) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00010517) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME90225) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2016-06-30 |