| NPI | 1356305973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 52070) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101056519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A106403) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 056092) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2025-04-23 |