| NPI | 1952394140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 40306) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 000035462) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2013-09-12 |