| NPI | 1124589387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T2114) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T2114) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-06-30 |