| NPI | 1124447107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD486849) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q8099) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 61720) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2025-07-02 |