NPI | 1164508628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G80929) |
Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: CA G80929) |
2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA G80929) | |
Enumeration Date | 2006-10-27 |
Last Update Date | 2021-10-21 |