| NPI | 1265840276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD471455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207150) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 282461) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2024-12-02 |