| NPI | 1295993871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 8495680-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 149032) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 8495680-1205) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2013-11-14 |