| NPI | 1164698460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: TX U2675) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: GA 63755) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX U2675) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2675) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U2675) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2025-03-11 |