| NPI | 1982019113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 008554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R2432) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 008554) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2022-12-28 |