| NPI | 1518925122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD30031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0065296) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0065296) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2024-12-13 |