| NPI | 1760463673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L6109) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 223375) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-01-27 |