| NPI | 1063533149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 69938) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 27363) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 69938) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.203359) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2025-11-18 |