| NPI | 1053577890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q3852) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-50261) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q3852) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD-50261) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2022-12-06 |