| NPI | 1083908834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IA R-10062) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA R-10062) |
| 207T00000X Neurological Surgery (Licence: IA R-9085) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IA R-10062) | |
| 2085H0002X Radiology, Hospice and Palliative Medicine (Licence: IA R-10062) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: IA R-10062) | |
| 2085N0700X (Licence: IA R-10062) | |
| 2085N0904X (Licence: IA R-10062) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-10062) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463839) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: IA R-10062) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA R-10062) | |
| 2085R0205X Radiology, Radiological Physics (Licence: IA R-10062) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: IA R-10062) | |
| 208D00000X General Practice (Licence: FL ME137781) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2025-02-16 |