| NPI | 1255315057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD224202) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2008-0074) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2008-0074) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2026-08-12 |