| NPI | 1053638981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2013-0574) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 37154) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 19035A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0075798) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2025-10-29 |