| NPI | 1790020600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS018054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101019488) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101019488) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA OS018054) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2017-10-26 |