| NPI | 1225141328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301081063) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me92656) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2023020198) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME92656) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL ME92656) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-04-25 |