| NPI | 1487004529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 10516421-1205) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA R-16072) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10516421-1205) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2023-07-14 |