| NPI | 1912199068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A115140) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A115140) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-04-16 |