| NPI | 1598044661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S9785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 279018) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461688) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2021-07-27 |