| NPI | 1700883154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 31847) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 20717) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C38560) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 20717) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C38560) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 31847) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-01-09 |