| NPI | 1790776987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: RI 07773) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI 7773) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2015-06-17 |