| NPI | 1700178159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63588) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q5374) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME133437) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q5374) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2022-08-30 |