| NPI | 1730422429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V9874) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 21440) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD93722) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 6734) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-07-15 |