| NPI | 1336452036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0081174) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD043863) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0081174) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD043863) | |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2019-01-07 |