| NPI | 1992004527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2016013264) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2016013264) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME173338) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2026-03-11 |