| NPI | 1871549287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME100529) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D63340) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-02-22 |