| NPI | 1538255286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX K9207) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G80629) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 40071) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-05-12 |