| NPI | 1699090654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N6820) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MT196154) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2024-07-16 |