| NPI | 1750728549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D94548) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D94548) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD467021) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2025-06-03 |