| NPI | 1417182007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 48831) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MS 23506) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD0000048831) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2016-08-03 |