| NPI | 1710396791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2026028667) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD224607) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 62124) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2026-07-27 |