| NPI | 1619936085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 16733) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 37227) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 16733) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 37227) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2024-03-17 |