| NPI | 1619143914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 84342) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 51504) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2025-09-08 |