| NPI | 1821053935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9401497) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 20869) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 20869) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 9401497) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2017-12-20 |