| NPI | 1043425614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C160846) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101228434) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101228434) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-10-18 |