| NPI | 1972704807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M9195) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID 1771495) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2026-08-03 |