| NPI | 1710320569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA OS019015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C7-0005338) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS019015) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2026-02-19 |