| NPI | 1700264579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 327241) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 327241) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 61371) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2024-08-07 |