| NPI | 1255618757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0102204883) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD H0088777) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0102204883) | |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2025-06-25 |