| NPI | 1407176407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 9842749-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2013-01871) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2021-11-12 |