NPI | 1760863005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME150345) |
Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 0000056462) |
2085R0202X Radiology Diagnostic Radiology (Licence: FL ME150345) | |
2085R0202X Radiology Diagnostic Radiology (Licence: TN 0000056462) | |
Enumeration Date | 2015-06-12 |
Last Update Date | 2023-12-07 |