| NPI | 1417397738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24876) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60945854) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO TL.0006956) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2024-07-16 |