| NPI | 1194700823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME75401L) |
| Additional Taxonomies | 261QR0200X Clinic/Center Radiology (Licence: FL HCC8516) |
| 261QP3300X Clinic/Center Pain (Licence: FL PMC1621) | |
| 261QP3300X Clinic/Center Pain (Licence: FL PMC1664) | |
| 261QP3300X Clinic/Center Pain | |
| 261QP3300X Clinic/Center Pain (Licence: FL PMC1756) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-09-26 |