| NPI | 1790573145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 3018098) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 3018098) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |