| NPI | 1013447820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 70459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 1952347205) |
| 282N00000X General Acute Care Hospital (Licence: NY 7003010H) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-04-29 |