| NPI | 1437305000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD55071) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD55071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.121285) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 25252) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101246158) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD038209) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0079255) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2022-04-06 |