| NPI | 1245266972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L2573) |
| Additional Taxonomies | 202K00000X (Licence: TX L2573) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L2573) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2205) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2021-04-09 |