| NPI | 1891731832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A 10654) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 34435) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 20A 10654) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-02-11 |