NPI | 1679545438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL 20808) |
Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 00020808) |
2085R0202X Radiology Diagnostic Radiology (Licence: FL ME91839) | |
2085R0202X Radiology Diagnostic Radiology (Licence: TX J9740) | |
Enumeration Date | 2006-02-06 |
Last Update Date | 2016-06-27 |