| NPI | 1396034468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA MD.205464) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME125351) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.205464) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME125351) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2019-03-19 |