| NPI | 1962805598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 21094) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 21094) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 31504) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2020-11-18 |