| NPI | 1679545438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL 20808) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 00020808) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME91839) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX J9740) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2016-06-27 |