| NPI | 1063410157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 350326-1205) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 350326-1205) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-02-26 |