| NPI | 1780613240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX K8154) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD428785) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 51583) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-10-07 |