| NPI | 1962723114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 15091) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LP02321) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 15091) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2015-11-17 |