| NPI | 1376696658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0507) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD438111) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD438111) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX Q0507) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q0507) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2014-09-18 |