| NPI | 1003800418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 6280) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AL 00006280) |
| 2085N0700X Radiology, Neuroradiology (Licence: FL ME89649) | |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 020134) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00006280) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME89649) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 020134) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2016-06-30 |