| NPI | 1386614337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1015938) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME EC081049) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1015938) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 263565-1) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 82171) | |
| 208D00000X General Practice (Licence: VA 0101237373) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-05-18 |