| NPI | 1801880364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 43080) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 043080) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 43080) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2018-09-26 |