| NPI | 1346447786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME115115) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: FL ME115115) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101247834) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 2011-00896.) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101247834) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: FL MS115115) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2018-06-11 |