| NPI | 1659565885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL TRN 11859) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD441803) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2015-05-01 |