| NPI | 1033438098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301091875) |
| Additional Taxonomies | 2085N0700X (Licence: MI 4301091875) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301091875) | |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2026-01-30 |