| NPI | 1790019347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q2900) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX Q2900) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2024-06-20 |