| NPI | 1275714958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 45887) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 45887) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 19296) | |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2018-09-05 |