| NPI | 1992905095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 51872) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2014-0823) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N6601) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 51872) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX N6601) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2014-0823) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-09-26 |