| NPI | 1205082401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A104307) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104307) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2025-08-27 |