| NPI | 1962459396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX k1006) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX K1006) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX k1006) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX k1006) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TX k1006) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2009-01-06 |