| NPI | 1902800329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 00504) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 22750) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 00504) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22750) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2017-12-20 |