| NPI | 1083024830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 75145) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID 3771083) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 3771083) | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2025-12-11 |