| NPI | 1578763355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 996437) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 31693) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q9958) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 30970) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60343987) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2026-07-21 |