| NPI | 1629138409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00039131) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD20396) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD20396) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2026-02-17 |