NPI | 1063919801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 195923) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 320324) |
Enumeration Date | 2018-04-09 |
Last Update Date | 2024-05-02 |