| NPI | 1952367930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 34941) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 16156) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 16156) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 34941) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-12-20 |