| NPI | 1316562069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86990-20) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 86990-20) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2026-06-15 |