| NPI | 1659698942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 0000049849) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 301659) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 49849) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 26811) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2023-11-17 |