| NPI | 1104288364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX U7237) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-17230) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U7237) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U7237) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2025-10-20 |