| NPI | 1801160874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: ID 1571767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A119657) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID 1571767) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A119657) | |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2025-07-11 |