| NPI | 1235117169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD27493) |
| Additional Taxonomies | 2085N0700X (Licence: MA 154492) |
| 2085N0700X (Licence: NH 11784) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 11784) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 154492) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2024-08-05 |