| NPI | 1720228778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME120107) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 16520) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 60111) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 12822C) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-180) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME120107) | |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2023-09-19 |