| NPI | 1609840685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241692) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101241692) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0056626) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 35806) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-03741) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2026-08-07 |