| NPI | 1164634770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR 157199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.60212410) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD.60212410) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 157199) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2012-10-15 |