| NPI | 1003344185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: WV 35464) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 35464) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2025-08-06 |