| NPI | 1962722702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P2175) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 390200000x) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA 60192680) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2022-01-14 |