| NPI | 1225349822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 58193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019030117) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2019030117) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2025-10-29 |