| NPI | 1578680302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101245477) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 01012455477) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2016-02-08 |