| NPI | 1013232065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P0907) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P0907) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2021-06-16 |