| NPI | 1639150055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 37760) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 32097) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 32097) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI 37760) | |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2026-01-22 |