| NPI | 1821169509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 26417) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45876) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 45876) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-07-30 |