| NPI | 1316398001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S7095) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2026-04177) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2026-08-18 |