| NPI | 1487816617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-1557) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 61827) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME115369) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME115369) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2010-01551) | |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2016-10-04 |