| NPI | 1326331133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 17033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 72627) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 11351657-1205) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2019-10-04 |