| NPI | 1518917582 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD196531) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120637) | 
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A120637) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60182547) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 17826) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2018-0045) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY C4055) | |
| Enumeration Date | 2006-05-11 | 
| Last Update Date | 2025-08-04 |