| NPI | 1699769315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00030) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 31521) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 052158) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 31521) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2019-01-23 |