| NPI | 1821230434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N8324) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N8324) |
| 208D00000X General Practice (Licence: VA 0116021630) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2019-05-18 |