| NPI | 1366013088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 59763) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: KY FT626) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY FT626) | |
| Enumeration Date | 2021-07-03 |
| Last Update Date | 2025-07-17 |