| NPI | 1124009204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L0895) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L0895) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2015-03-26 |