| NPI | 1831517382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0062199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2020-0307) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2020-0307) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0062199) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2023-03-14 |