| NPI | 1972554764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME144351) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MI 4301086925) |
| 2085B0100X Radiology Body Imaging (Licence: FL ME144351) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301086925) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301086925) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-04-17 |