| NPI | 1053638981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0075798) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 19035A) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 37154) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2026-07-31 |