| NPI | 1598256703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 36117) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 36117) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2026-01-21 |