| NPI | 1649255878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q5479) |
| Additional Taxonomies | 2085N0700X (Licence: NC 200001406) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 200001406) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2016-07-25 |