| NPI | 1255423489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A78149) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A78149) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-05-26 |