| NPI | 1770857427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A126057) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD442652) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2024-11-15 |