| NPI | 1609210632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD194533) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000053944) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD0000053944) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2020-05-07 |