| NPI | 1649536301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: UT 14213083-1235) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NY 287747) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60845644) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 287747) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD187654) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 287747) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2025-04-22 |