| NPI | 1972718229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 96-00365) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 96-00365) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 96-00365) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101245759) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101245759) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2015-11-12 |