| NPI | 1205213071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 302514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145454) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 302514) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NJ 25MA11637100) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME145454) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2023-07-06 |