| NPI | 1083827992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60681523) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088520) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101256955) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60681523) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 54901) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-05-24 |