| NPI | 1306647581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MDRE.ML.70106827) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID 7271468) |
| Enumeration Date | 2025-03-22 |
| Last Update Date | 2026-06-25 |