| NPI | 1942516521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX 46343) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 78722) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 21793) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2025-07-02 |