| NPI | 1215170972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0011791) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0011791) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0011791) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0095506) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2026-08-25 |