| NPI | 1730593021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 24127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2014018364) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2016041067) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2024-02-01 |