| NPI | 1811943715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: MD D15753) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D15753) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D15753) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-08 |