| NPI | 1770979767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 88974) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88974) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61048424) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61048424) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2022-08-09 |