| NPI | 1720066749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX H5565) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H5565) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2019-07-10 |