NPI | 1962668855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD451295) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2013018542) |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2013018542) | |
Enumeration Date | 2008-07-31 |
Last Update Date | 2019-01-17 |