| NPI | 1871593848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA ME 13445) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME13445) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2008-06-25 |