| NPI | 1710182407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD600004378) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-26380-0) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL 111866) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2026-07-28 |