| NPI | 1215235916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX R3055) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 973) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R3055) | |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2026-06-12 |