| NPI | 1992967699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 13466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01382) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 13466) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 277732) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 277732) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-03-27 |