| NPI | 1174789754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD14634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003435) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14634) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 14634) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 14634) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1020028) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2024-04-19 |