| NPI | 1861492902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 42410) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 42410) |
| 2085B0100X Radiology, Body Imaging (Licence: MN 42410) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2012-06-15 |