| NPI | 1063679447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 284150-01) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 46303) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME153519) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2024-03-19 |