| NPI | 1255428355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200001075) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD34971) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023049402) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 101363) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD34971) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2024-12-02 |