| NPI | 1922024942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0086283) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A70967) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A70967) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-01-23 |