| NPI | 1508153685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R4143) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP10040576) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2023-03-24 |