| NPI | 1073562419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L9832) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L9832) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-07-15 |