| NPI | 1104245208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 313825) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 313825) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-05-25 |