| NPI | 1447423322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 9895A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N9654) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MT 31900) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SD 9168) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WY TL2573) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2021-05-12 |