| NPI | 1861768103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 29125) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107087) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 56913) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56913) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 29125) | |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2026-08-03 |