| NPI | 1104998137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 37113) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 5384574-1205) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: ID M14927) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MT MED-PHYS-LIC-80205) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WY 12595A) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-03-13 |