| NPI | 1023467495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X (Licence: CA A200905) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 70377) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 70377) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-06-27 |