| NPI | 1225491889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U9076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD494376) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD494376) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2026-05-22 |