| NPI | 1659546232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P0230) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 135338) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2012-07-16 |