| NPI | 1811164452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0852) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 345267) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 345267) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q0852) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2025-09-29 |