| NPI | 1194950022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 31417) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 275247) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N8102) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2021-01-13 |