| NPI | 1538167804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD058309L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD058309L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 47945) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME142569) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 47945) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2024-01-05 |