| NPI | 1629064951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD455779) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101057439) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 52212) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD455779) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101057439) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 52212) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2019-05-03 |