| NPI | 1407019334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C181304) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 7751) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD455415) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP784) | |
| 282N00000X General Acute Care Hospital (Licence: PA MT193667) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2024-01-25 |