| NPI | 1104864461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ID MC-1509) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M3035) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M3035) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-09-01 |