| NPI | 1033417571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 62846) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MN 62846) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 62846) | |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2023-09-26 |