| NPI | 1881219962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101288295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT221366) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2026-06-29 |