| NPI | 1104188879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-14181) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: ID M-14181) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NH RT3082) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-05-16 |