| NPI | 1780988071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME114710) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT193498) |
| Enumeration Date | 2011-01-01 |
| Last Update Date | 2013-08-13 |