| NPI | 1972782951 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 55120) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55120) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2016-03-03 |