| NPI | 1497041396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S4357) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: HI DOS-1468) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2025-06-16 |