| NPI | 1659462323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 63593) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L1121) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 211258) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2019-07-12 |