| NPI | 1730126475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 162938-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 162938-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-4291) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-09-04 |