| NPI | 1679590111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MO 1999134578) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 1999134578) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-04-17 |