| NPI | 1609899384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: LA MD.11281R) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.11281R) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-03-06 |