| NPI | 1083877799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME134056) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 33323) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-09-01 |