| NPI | 1275826398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A156011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 558755) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2022-02-11 |