| NPI | 1801328414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX U2877) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 319822) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2025-02-24 |