| NPI | 1235542655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD15338) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282882) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15338) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 282882) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2024-10-23 |