| NPI | 1780701219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00755) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 34339) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 34339) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2010-00755) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2017-12-20 |