| NPI | 1558700716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 57732) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7145) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 57732) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2019-08-14 |