| NPI | 1154599314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA C158962) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 235675) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX BP20042625) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX P5463) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2023-12-15 |