| NPI | 1578730115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-01182) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA MD203703) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME114992) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2014-01182) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 2014-01182) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: NC 2014-01182) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2014-07-08 |