| NPI | 1700825940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD25800) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 25800) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-11-30 |