| NPI | 1477871275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3203) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP2 - 0037513) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P3203) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2024-03-06 |