| NPI | 1851611966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX P2948) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P2948) |
| 208D00000X General Practice (Licence: TX P2948) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2016-07-19 |