NPI | 1972881035 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 130456) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 130456) |
Enumeration Date | 2011-07-22 |
Last Update Date | 2019-01-11 |