| NPI | 1124445085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 282200) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 62833) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-04-29 |