| NPI | 1801898622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K9272) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 2000-186) |
| 174400000X Specialist (Licence: TX K9272) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX K9272) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-03-10 |