| NPI | 1760863005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME150345) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME150345) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 0000056462) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 92958) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 0000056462) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 92958) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2024-08-04 |