| NPI | 1841519832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 301168) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC LL35020) |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2016-10-20 |