| NPI | 1629423710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-105199) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MED-PHYS-LIC-105199) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MT MED-PHYS-LIC-105199) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10507809-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 61244911) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2022-07-05 |