| NPI | 1003182064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 282559) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2513) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2021-06-30 |