| NPI | 1689664989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J6111) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J8111) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX J8111) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2020-07-01 |