| NPI | 1073800330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 260315) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 390200000X) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260315) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-10-24 |