| NPI | 1124357926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 292167-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2009036451) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2009036451) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2018-05-08 |