| NPI | 1659529469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 205965) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.205965) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3286) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2026-06-19 |