| NPI | 1588645295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD33819) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000033819) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD0000033819) | |
| 2085N0700X Radiology, Neuroradiology (Licence: TN MD0000033819) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TN MD0000033819) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101048186) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-06-27 |