| NPI | 1285616508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 46780) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101242121) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L3458) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2026-01-26 |