| NPI | 1255622080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2589) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 241391) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 241391) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 241391) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 241391) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2012-08-09 |