| NPI | 1790895159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY FL032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA SP182) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA SP182) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY FL032) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-12-06 |