| NPI | 1912931072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 31042) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: AZ 31042) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2014-09-11 |