| NPI | 1902040207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME121247) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 45218) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2022-02-11 |