| NPI | 1487656062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M2436) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS012852) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M2436) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2008-02-15 |