| NPI | 1811164437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME DO2991) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 5101017886) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2021-04-12 |