| NPI | 1083242564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND PT22873) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 69553) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 69553) | |
| 207R00000X Internal Medicine (Licence: MN 30947) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-09-04 |