| NPI | 1790969012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 24031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 390200000X) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0070632) | |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2013-02-22 |