| NPI | 1124417571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 19771) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 19771) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 10784) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2024-07-16 |