| NPI | 1235191966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G130944) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 15563) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 32259) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 49253) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 037722) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME119478) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 037722) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-06-25 |