| NPI | 1699773721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 53317) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC 32473) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD53317) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-10-19 |