| NPI | 1376563700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2026034164) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 61905) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M8628) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY TP118) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2026-08-05 |