| NPI | 1205891025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 52309) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 52309) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01059085A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M1032) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301091459) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-08-10 |