| NPI | 1346232683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 040161) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: HI MD-16777) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2026-08-03 |