| NPI | 1669692059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GU M-1944) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD42582) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-1944) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD42582) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-03-16 |