| NPI | 1306064563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: RI 12864) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD12864) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI LP00309) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2019-04-04 |