| NPI | 1114118031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P7793) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL TRN 9452) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL TRN 10650) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2014-03-14 |