| NPI | 1659505691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 60533) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2015014956) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 35053) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2025-06-09 |