| NPI | 1861602088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-34308) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7402) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25969) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-08-08 |