| NPI | 1730331380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX P3894) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3894) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A98258) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2025-08-11 |