| NPI | 1164943015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2024012040) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-50873) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-05-15 |