| NPI | 1215068796 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P2859) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AR E-8838) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2859) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2023-08-11 |