| NPI | 1811612393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 66649) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: TN PENDING) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN PENDING) | |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2025-07-18 |