| NPI | 1073778320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL 35.135883) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.135883) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0068738) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD442419) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD442419) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2026-08-13 |