| NPI | 1427390897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q2588) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q2588) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 75538) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2025-11-02 |