| NPI | 1073715884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L6438) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI LP01185) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2018-07-11 |