| NPI | 1932212594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L7334) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L7334) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L7334) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-04-09 |