| NPI | 1891734570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301079844) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME90963) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036107517) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2011-09-26 |