| NPI | 1821430828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL 119713) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: IL 036131922) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2014-07-07 |