| NPI | 1326573775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 327901) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A184507) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT218952) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A184507) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2024-09-19 |