| NPI | 1730478900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME145856) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q6515) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX Q6515) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2024-03-22 |