| NPI | 1871514646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 14049) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 14049) |
| 208D00000X General Practice (Licence: NY 235290) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-11-07 |