| NPI | 1003251836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61132741) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31659) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61132741) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY TL5660) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0061931) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2021-04-27 |