| NPI | 1902915515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13593071-1205) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 37917) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-03-22 |