| NPI | 1649686171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 38449) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 38449) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301117365) | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2026-01-26 |