| NPI | 1306057310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2007022042) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006016918) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-12-31 |