| NPI | 1588056113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2023-02365) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A163722) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2024-08-12 |