| NPI | 1568720662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI lp03876) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 566803) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-07-21 |