| NPI | 1891929519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID M12844) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M12844) |
| Enumeration Date | 2009-05-09 |
| Last Update Date | 2020-06-09 |