| NPI | 1609139591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A156014) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A156014) |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2023-11-27 |