| NPI | 1326345257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 9685640-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA N/A) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2020-09-01 |