| NPI | 1801235627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME136201) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15058) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD15058) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-08-03 |