| NPI | 1164954723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MT214818) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME161234) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 333711) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2025-03-04 |