| NPI | 1194030544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P0614) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P0614) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.32115) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042.0013591) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2017-03-13 |