| NPI | 1376637165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 4759) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 4759) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PR 4759) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |