| NPI | 1063483154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 1435011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 1435011) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.150160) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME83378) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2026-08-10 |