| NPI | 1114458338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2024-01720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277385) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101277385) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-08-13 |