| NPI | 1750347589 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 051686) | 
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 051686) | 
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: GA 051686) | |
| 2085N0700X (Licence: GA 051686) | |
| 2085N0904X (Licence: GA 051686) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: GA 051686) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 051686) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME49311) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME49311) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: GA 051686) | |
| Enumeration Date | 2006-04-21 | 
| Last Update Date | 2024-05-23 |