| NPI | 1043484355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 47313) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N7488) |
| 208D00000X General Practice (Licence: KY 47313) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2016-10-10 |