| NPI | 1699792168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD49691) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 118069) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD064832L) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 118069) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD064832L) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 49691) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-03-21 |