| NPI | 1902966856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 6777) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 42515) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 42515) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-10-11 |