| NPI | 1265795223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 080547) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 080547) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2018-10-03 |