| NPI | 1447247994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 84-209) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 22047) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G5279) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 28061) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM 84-209) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-01-15 |