| NPI | 1578763108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 32564) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A91851) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 059711) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 32564) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A91851) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 059711) | |
| Enumeration Date | 2007-07-22 |
| Last Update Date | 2007-07-22 |