| NPI | 1306105531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A139637) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043740) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10043740) | |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2024-02-22 |