| NPI | 1376577254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 12975502-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301102862) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 002284) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 002284) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101244406) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301102862) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-12-03 |