NPI | 1205803897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C55447) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD34076) |
2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24914) | |
Enumeration Date | 2006-03-02 |
Last Update Date | 2022-10-18 |