| NPI | 1053874776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 60448) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2020011736) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 60448) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-06-24 |