| NPI | 1679647267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 059637) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 25565) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AL 25565) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-03-27 |