| NPI | 1467794818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX R9303) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2019-0225) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R9303) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2019-0225) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-12-06 |