| NPI | 1336305879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P5531) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 48315) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2018-12-10 |