| NPI | 1114178563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 39120) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD39120) |
| 2085N0700X (Licence: IA MD39120) | |
| 2085B0100X Radiology, Body Imaging (Licence: IA 39120) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P4192) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: IA MD39120) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2026-03-06 |