| NPI | 1104354729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2023-01699) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 316735) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101279011) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-08-22 |