| NPI | 1942401013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0011028) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: DE C1-0011028) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0011028) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2019-11-27 |