| NPI | 1215076344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S6340) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL L-2611) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 13335) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-06-29 |