| NPI | 1134507957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 35553) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP20057351) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-03-22 |