| NPI | 1114307287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101272862) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101272862) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025043999) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-55435) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A203311) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD-55435) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2026-02-25 |