| NPI | 1063405819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 51858) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036094621) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036094621) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 172012-1) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2019-06-04 |