| NPI | 1356842587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2026009007) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 32065) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2026-03-02 |