| NPI | 1962468579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME47268) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA G53338) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME47268) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2022-08-12 |