| NPI | 1437260957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239881) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101239881) |
| 2085B0100X Radiology, Body Imaging (Licence: VA 0101239881) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-03-19 |