| NPI | 1477846269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 68398) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 308743) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10040631) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2023-09-15 |