| NPI | 1679785653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 49706) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 49706) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 26121) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2005019104) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-36283) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 17527) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2023-11-17 |