| NPI | 1225458300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 73472) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 62973) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2020-09-01 |