| NPI | 1194984930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2021-03048) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-03048) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301092067) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101273805) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2025-10-01 |