| NPI | 1114245990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD70016363) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D83358) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 27788) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2025-08-20 |