| NPI | 1154857514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 102316) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2023024861) |
| 2085B0100X Radiology, Body Imaging (Licence: TX 47710) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2023024861) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX 47401) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX 47710) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2025-11-19 |