| NPI | 1740274158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00017267) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME41703) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 00017267) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME41703) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2011-11-02 |