| NPI | 1790102606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MT MED-PHYS-LIC-87579) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60566795) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-07-06 |