| NPI | 1063483154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 1435011) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME83378) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 1435011) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2008-02-20 |