| NPI | 1184243230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101289135) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A194604) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101289135) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2026-09-23 |