| NPI | 1679776819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S2667) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TX S2667) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-11-19 |