| NPI | 1912129693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 29795) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 054936) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2016-12-05 |