| NPI | 1417933219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX G6480) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: TX G6480) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX G6480) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX G6480) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2010-07-26 |