| NPI | 1740252139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX m0231) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M0231) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-02-26 |