| NPI | 1164508628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G80929) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA G80929) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G80929) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-10-21 |