| 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 |