| NPI | 1750303517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N3542) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 23805) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3542) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 09542R) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-07-10 |