| NPI | 1104829902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD063610L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD063610L) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2025-09-10 |