| NPI | 1699926824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301102261) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX U6116) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA 40422) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA R-8315) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA 40422) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2024-06-24 |