| NPI | 1619143245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00414) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0071873) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 37388) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0071873) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 37388) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2009-00414) | |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2017-12-20 |