| NPI | 1720044183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G82141) |
| Additional Taxonomies | 2085N0700X (Licence: CA G82141) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 75437) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 16266) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2026-08-12 |