| NPI | 1174528780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME80915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 21748) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2026-07-29 |