| NPI | 1306233911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME145491) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 304368) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD476844) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2024-10-27 |