| NPI | 1205156056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 10124686-8904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057965) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10124686-1204) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2020-09-01 |