| NPI | 1407394687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 31243) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101287568) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101287568) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2026-02-19 |