| NPI | 1508083478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P1046) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 49015) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-05-11 |