| NPI | 1982679585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 33043) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 33043) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A102453) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IN 01067581A) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2022-06-29 |