| NPI | 1871737007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME134472) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3704) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2026-04-07 |