| NPI | 1740519321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX 43644) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX 43644) |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2023-12-07 |