| NPI | 1669816658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 82297) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 82297) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q6770) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-01-18 |