| NPI | 1992150221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T0419) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T0419) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22967) | |
| Enumeration Date | 2016-04-23 |
| Last Update Date | 2025-11-12 |