| NPI | 1154536530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX V2887) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID 4181602) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2026-05-06 |