| NPI | 1336353978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME126311) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 24855) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101253202) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 24855) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101253202) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-04 |