| NPI | 1730566654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V2980) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2022-02787) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE 00000) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.069298) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE 000000) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2025-08-12 |