| NPI | 1003026329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME133384) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 265984) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 265984) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CT 048378) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-04-24 |