| NPI | 1265425441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 1908241) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: NY 1908241) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 1908241) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2007-07-08 |