| NPI | 1255339420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 213195-1) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 213195) |
| 2085R0205X Radiology Radiological Physics (Licence: NY 2131951) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-03-31 |