| NPI | 1326336637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME 126623) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060082) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2021-11-01 |