| NPI | 1700875788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017004467) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: UT 6035963-1205) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: UT 6035963-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6035963-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 11771) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2017004467) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2017-05-02 |