| NPI | 1801110101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 13303) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT193226) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 8614430-1205) | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2014-08-06 |