| NPI | 1619288016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A156659) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301109102) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME121328) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.120362) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A156659) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME121328) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2018-09-13 |