| NPI | 1376514026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-00560) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME77952) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME77952) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2025-08-22 |