| NPI | 1194085704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 293710) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 67208) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 293710) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2025-10-21 |