| NPI | 1205803897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 11513652-1205) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C55447) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD34076) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24914) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2025-12-29 |