| NPI | 1740507342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A135996) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A135996) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2025-05-08 |