| NPI | 1114194537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2010-00164) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 141990) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2023-03-10 |