| NPI | 1275604621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R8688) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MO R8688) |
| 2085N0700X (Licence: MO R8688) | |
| 2085N0904X (Licence: MO R8688) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO R8688) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MO r8688) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO R8688) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MO R8688) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-09-22 |