| NPI | 1811964554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 34995) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: TN 34995) |
| 2085B0100X Radiology Body Imaging (Licence: GA 049910) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 049910) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 34995) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 049910) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2018-02-22 |