| NPI | 1255863973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U6937) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 98314) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 05714) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS20752) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 22922) | |
| 171000000X Military Health Care Provider | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 340302) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02007569A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101027923) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM DO2025-0007) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6937) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61510497) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 327321) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2026-05-01 |