| NPI | 1194968263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 53469) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI FJ3394967) |
| Enumeration Date | 2009-04-19 |
| Last Update Date | 2015-11-07 |