| NPI | 1689859829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101254528) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 235173) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 235173) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD435000) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 27887) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD435000) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2021-03-09 |