| NPI | 1902888704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G29660) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G29660) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2023-11-17 |