| NPI | 1598913980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 49166) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C192087) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35C.000853) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME162690) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-1306) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2024-03-21 |