| NPI | 1538576483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T5805) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61464114) |
| 208000000X Pediatrics (Licence: WA MD61464114) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T5805) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2023-12-08 |