| NPI | 1912135997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S8923) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine, Nuclear Imaging & Therapy (Licence: NY 267243) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2017022649) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 267243) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2021-05-31 |