| NPI | 1154687549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: NC 2022-00424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 11670A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0060901) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31062) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036137338) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2022-04-28 |