| NPI | 1063919801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA 195923) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 320324) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-05-02 |