| NPI | 1760643365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N3461) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TX N3461) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: AR E-12162) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-12162) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3461) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2021-11-16 |