| NPI | 1144456484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 261145) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 261145) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2021-07-27 |