| NPI | 1679747265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 274986) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 78295) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MD D71136) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2025-08-25 |