| NPI | 1942598990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301098779) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301098779) |
| 208D00000X General Practice (Licence: MI 4301098779) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0056088) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2025-04-25 |