| NPI | 1811993066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 28234) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 44702) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 34334) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2015-09-22 |