| NPI | 1265646806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GU M-1142) |
| Additional Taxonomies | 2085N0904X (Licence: GU M-1142) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-1142) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GU M-1142) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-12-09 |