| NPI | 1841226214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 64268) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 98-01779) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 98-01779) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2013-01-17 |