| NPI | 1437133170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101268718) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NC 200200206) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 40223) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200200206) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 200200206) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2021-11-01 |