| NPI | 1023066404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 28916) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD041221E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0011573) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD041221E) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0011573) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 63241) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-10-17 |