| NPI | 1831180082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME86904) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD039114L) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2018-07-31 |