| NPI | 1548611726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD478445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211486) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2023-07-03 |