| NPI | 1225418361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID M-17471) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61199843) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD206381) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2026-07-29 |