| NPI | 1386821171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U7910) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A116596) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U7910) | |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2024-01-09 |