| NPI | 1730189739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME88184) |
| Additional Taxonomies | 202K00000X (Licence: FL ME88184) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2020-09-22 |