| NPI | 1609336254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 85330) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 85330-20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 3103) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-09-12 |