| NPI | 1639407083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N2514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX n2514) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2023-12-08 |