| NPI | 1578811741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX P8273) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60770415) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX P8273) | |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2023-12-11 |