| NPI | 1578772687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301086248) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301086248) |
| 208600000X Surgery (Licence: MI 4301086248) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |