| NPI | 1114916251 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101050069) | 
| Additional Taxonomies | 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: TN 41428) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101050069) | |
| Enumeration Date | 2005-10-20 | 
| Last Update Date | 2025-09-21 |