| NPI | 1265722078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0058387) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO DR.0058387) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2020-06-23 |