| NPI | 1841298833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CT 44196) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 187193) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD45416) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101257691) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D79532) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2017-04-11 |