| NPI | 1275731200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX Q8840) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA OP60043616) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q8840) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA OP60043616) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: WA OP60043616) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX Q8840) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2025-04-17 |