| NPI | 1104883693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M2393) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 66080) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD466458) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11513800) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-14051) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 26866) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M2393) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AR E-14051) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2025-09-04 |