| NPI | 1558345777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: GA 90728) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G89386) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 28391) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 28391) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2022-07-13 |