| NPI | 1982830063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA md207720) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD041980) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 49074) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2023-11-19 |