| NPI | 1679596910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX K7374) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX K7374) |
| 2085B0100X Radiology Body Imaging (Licence: TX K7374) | |
| 2085N0700X Radiology Neuroradiology (Licence: TX K7374) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: TX K7374) | |
| 2085R0001X Radiology Radiation Oncology (Licence: TX K7374) | |
| 2085R0203X Radiology Therapeutic Radiology (Licence: TX K7374) | |
| 2085R0205X Radiology Radiological Physics (Licence: TX K7374) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX K7374) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX K7374) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-08-15 |