| NPI | 1063459691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0039981) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 663) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 05-36637) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MT 141398) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI DOS1589) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-07-09 |