| NPI | 1780624254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6013) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 22342) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M6013) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-08-15 |