| NPI | 1255508644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 23872) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD448253) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 23872) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2025-08-29 |