| NPI | 1982867420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301100455) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX BP10034816) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 002928) | |
| 208D00000X General Practice (Licence: MI 4301100455) | |
| Enumeration Date | 2008-07-04 |
| Last Update Date | 2015-06-09 |