| NPI | 1255366332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 039359) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 039359) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 206450-1) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-06-30 |