NPI | 1609210129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME120997) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S0099) |
2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57448) | |
2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME120997) | |
Enumeration Date | 2013-04-26 |
Last Update Date | 2023-11-26 |