| NPI | 1679951511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T8176) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T8176) |
| 208600000X Surgery (Licence: TX BP10052436) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-09-26 |