| NPI | 1639310550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P1094) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P1094) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2015-09-10 |