| NPI | 1295117687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T4430) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4430) |
| 208D00000X General Practice (Licence: NE 29430) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-11-09 |