| NPI | 1134388200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME158696) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX T3159) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX T3159) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2023-04-12 |