| NPI | 1083641005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD045193E) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MD045193E) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: PA MD045193E) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD045193E) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP596) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY TP596) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PA MD045193E) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-10-16 |