| NPI | 1356322887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000039150) |
| Additional Taxonomies | 2085N0904X (Licence: TN MD0000039150) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD0000039150) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2009-12-28 |