| NPI | 1508806233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 371396-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 371396-1205) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10604) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2013-01-08 |