| NPI | 1962728162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 18408) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P6102) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 18408) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2018-08-08 |