| NPI | 1114916251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 41428) |
| Additional Taxonomies | 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: TN 41428) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD41428) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-10-08 |