| NPI | 1801208749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101269235) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LP03119) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA 60941274) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2024-02-14 |