| NPI | 1336345248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 295487) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME113460) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME113460) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 45958) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2023-05-11 |