| NPI | 1922081025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 12648R) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD069453L) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 12648R) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-03-25 |