| NPI | 1962480277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 93-00294) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NC 93-00294) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2012-11-12 |